A combination of rising pollution levels and cold weather has disproportionately affected young children, many of whom are less than a year old. They are being diagnosed with bronchitis, bronchiolitis, pneumonia, asthma and other respiratory illnesses.
Some hospital wards incorporate up to three children per bed in order to maximise the use of limited equipment such as oxygen cylinders.
At New Delhi’s Lok Nayak Hospital, resident doctors cannot seem to catch a breath. The constant influx of patients has them balancing between paperwork and diagnoses.
“Around 40-50 percent of admitted children are respiratory cases,” a second-year doctor in one of the 12 paediatric wards at the hospital told ThePrint. “And 10-15 percent of these cases are severe.”
November to February is the period when hospitals across Delhi see an increase in the number of children with respiratory illnesses.
“While we cannot attribute it specifically to pollution, respiratory cases reported from November to February have increased by 20-25 percent in the last few years,” the doctor added.
Although studies are being conducted on the effects of air pollution on children, there is a common consensus among doctors that adverse air quality has played a major role in the increase in respiratory illnesses and distress.
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Pollution affects children the worst
One of the major causes of death in children is respiratory illness, compared to heart disease in adults. Children up to the age of 5 are most susceptible to respiratory infections due to their underdeveloped lungs and immune system.
“Their airways are narrower and their chests are not very pliable to allow for respiratory compromises,” Dr Aheed Khan, a paediatrician and neonatologist, told ThePrint.
As a result, children get into respiratory distress very quickly. “We have seen an increase in cases of bronchiolitis, which is the inflammation and infection of these small airways,” Dr Khan said.
Any small change in the radius of these airways impacts the flow of air.
“Whenever a pollutant gets into the body, there is increased mucus secretion in the lungs,” Dr Khan added. “There is a mechanism in the lung which pushes out PM (particulate matter).”
When air pollution increases, the body is suddenly exposed to large amounts of contaminants which it then tries to get rid of. Airways are more prone to infection at such a time.
“Whenever pollution rises, there is an increase in children being admitted to hospitals,” Dr Khan said. “Any small cold can concomitantly cause a bigger infection like bronchiolitis.”
Kalawati Saran Children’s Hospital, part of Lady Hardinge Medical College, has several wards filled with children across ages recovering from respiratory illnesses.
Khusboo, a mother of two, was looking after her four-year-old daughter, who was recovering from pneumonia.
“It is definitely because of pollution,” Khusboo told ThePrint. “The doctors said there is water retention in my daughter’s lungs and she will most likely be discharged within 10 days.”
While Khusboo and her husband wait at the hospital, her six-year-old son is at home with relatives.
And though the air quality has not visibly affected her son’s health, it has impacted other aspects of his life.
“Since the schools have moved to online classes [because of the bad air quality], he has stopped studying,” Khusboo said.
Capacity constraints
Children with comorbidities—the presence of two or more medical conditions in a patient—face an even greater challenge.
A father from Meerut, Uttar Pradesh travelled close to 80 kilometres to take his four-month-old son to hospitals in Delhi.
“About three months ago, my child’s breathing seemed irregular. We did an echo scan in Meerut which revealed that he had a hole in his heart,” the father told ThePrint.
His child then caught pneumonia in late November due to adverse weather conditions.
Doctors in his hometown said his son’s pneumonia needed to be cured before they could operate on the heart. But in the emergency ward at Lok Nayak Hospital, doctors gave him conflicting advice—fix your child’s heart first.
He could not immediately admit his child at Lok Nayak’s ICU (intensive care unit) either. Beds are limited, and numbers are allotted to prospective patients on a first-come first-serve basis.
A number does not guarantee admission.
It is not just ICUs that have limited space. Chacha Nehru Bal Chikitsalaya’s regular wards are overflowing with children.
“There is a government directive to admit patients, but there is no policy for one child per bed,” an overworked doctor told ThePrint while doing his rounds. “All the beds are overloaded. As you can see, there are two-three children per bed.”
The doctor specifically pointed at pollution as a huge driving force for the increase in respiratory illnesses.
“We have seen a tremendous increase in the number of children admitted on account of respiratory disorders. Specifically because of the pollution post Diwali season,” the doctor said.
And while the hospital does have equipment to treat respiratory disorders, doctors need to “rationalise which patient needs equipment more”, he added.
Kalawati sees the most severe cases as a tertiary care hospital.
The increase in the number of admitted children with respiratory illnesses has inevitably led to an increase in deaths.
“We are used to deaths,” a third-year resident doctor at Kalawati told ThePrint. “Maybe we were affected by deaths in our first two years, but now we are accustomed to it.”
‘Air purifiers a luxury’
As a government hospital, Kalawati gets patients primarily from lower-income families.
Doctors don’t believe that parents are aware of the impact pollution is having on their children.
“The realisation of pollution is less. To take any action, they need to realise how the increase in pollution is impacting the health of their children,” a first-year resident doctor told ThePrint.
Dr Khan believes that while government initiatives and social media are creating awareness, some families have no option but to continue with their lives.
“A child I saw 10 days ago developed respiratory distress after the mother took him outside to a market,” said Khan.
Asked why she took the child out, the mother responded that since she was single, she could not leave the child anywhere else.
“You have to eventually breathe the air of the city. People say air purifiers are a necessity, but for a lot of families, these are expensive devices and a luxury,” Dr Khan said.
It is not just the short-term impact of poor air quality that is worrying.
A doctor from Guru Teg Bahadur Hospital, New Delhi told ThePrint that in the long term, respiratory illnesses can stunt growth, weaken the immune system, cause asthma and impact cognitive development.
This is not just a seasonal problem either.
Delhi’s daily average AQI in 2023 was 204, according to a statement by the Union Ministry of Environment, Forest and Climate Change.
In 2023, the daily average AQI in Delhi increased in November and December compared to that the previous year.
Apart from 2020, during the COVID-19 pandemic, the daily average AQI in the national capital has been above 200 since 2018.
“Even 200 is bad,” the doctor from Guru Teg Bahadur Hospital quoted above said. “The ideal AQI is below 50. But only when it crosses 700 does it ruffle feathers.”
Outside the paediatric wards, parents wait with their coughing children for an appointment with the on-call doctors.
Some parents only take their children to hospitals when their conditions become severe.
Mohammed Arif sits outside a ward waiting with his youngest child. His elder daughter, aged eight, has been experiencing coughs every winter for the past several years.
He has not taken her to a hospital yet.
To him, cough syrup is enough to stem the tide of Delhi’s harsh winters.
(Edited by Radifah Kabir)
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